Non-steroide antiinflammatoriske præparaters påvirkning af knogleheling
Introduktion – Non-steroide antiinflammatoriske præparater (NSAID) anvendes hyppigt i forbindelse med postoperativ smertekontrol efter kirurgiske indgreb på kæberne. Præparaternes virkning beror på hæmning af enzymet cyclooxygenase, der bl.a. er en vigtig regulator af den inflammatoriske proces. Formålet med denne litteraturgennemgang er at vurdere NSAID’s mulige påvirkning af knogleheling med særlig vægt på implantatindsættelse og rekonstruktive procedurer i det orale område. Metode – Der er gennemført en litteratursøgning i Medline/PubMed. Resultater – To humane randomiserede kontrollerede studier, fire dyreeksperimentelle og to laboratorieundersøgelser blev identificeret. I ét humant studie var der ingen signifikant forskel i marginalt knogleniveau omkring implantater på patienter behandlet med NSAID sammenlignet med patienter behandlet med placebo vurderet røntgenologisk ½ år postoperativt. Ligeledes kunne der i det andet humane studie ikke påvises nogen effekt af NSAID-behandling på knogleniveauet i membranbehandlede parodontale defekter. Tre ud af fire dyreforsøg samt to studier på celleniveau gav mistanke om, at NSAID påvirker knoglenydannelse ved regenerative procedurer. Det skal dog understreges, at ingen af dyreforsøgene involverede kæberne. Konklusion – Der er ikke påvist en negativ effekt på knogleheling omkring implantater ved samtidig smertebehandling med NSAID i humane studier. Enkelte dyreeksperimentelle undersøgelser og laboratorieundersøgelser indikerer, at NSAID kan have en negativ effekt på knogleheling. De dyreeksperimentelle undersøgelser involverede imidlertid ikke kæberne. Der er derfor behov for supplerende humane randomiserede forsøg til at af- eller bekræfte, om NSAID påvirker knoglenydannelse inden for det orale område.
Klinisk relevans:
Non-steroidal anti-inflammatory agents influence on bone healing
Introduction – Non-steroidal anti-inflammatory drugs (NSAID) are often used for postoperative pain control after surgical procedures in the oral and maxillofacial area. Their anti-inflammatory effect is due to regulation of the enzyme COX-2, a catalyst for the production of prostaglandin-2, which is known to be a key regulator of inflammation. The aim of this article is through a systematic search of the literature to reveal current knowledge as to whether NSAID is affecting bone healing in the craniofacial area. Material and method – A search in electronic database (Medline/ PubMed) with the following key-words (Mesh-terms):”bone regeneration” OR ”fracture healing” AND “anti-inflammatory agents, non-steroidal” was conducted. The articles in English concerning the maxillofacial area were selected and described systematically. Results – Two minor randomised human studies, four animal stu dies and two laboratory studies were identified. One human study could not find a significant difference on bone level six month after implant insertion, evaluated radiographically in patients receiving NSAID, compared to the control group. Another human study found no significant difference in bone level in membrane treated parodontal defects. Three of four animal studies and the two laboratory studies showed a significant reduction in bone implant contact and in osteoklast differentiation. None of these studies were conducted in jawbone. Conclusion – Two human randomised clinical studies could not find a significant difference on bone healing around implants in patients receiving NSAID compared to controls. Animal and laboratory studies have indicated a negative effect on bone healing. As results from animal and laboratory studies are not directly referable to a human setting, further investigations are needed to disclose whether NSAID affects bone healing after reconstructive procedures.
